340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ALLINA HEALTH WESTHEALTH PHARMACY
DSH240115F MERCY HOSPITAL
Print
Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Courage Kenny Kids
Type
Disproportionate Share Hospital
340B ID
DSH240115F
Entity Address
3960 Coon Rapids Blvd NW
123
Coon Rapids, MN 55433-2569
Medicare Provider Number
240115
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH WESTHEALTH PHARMACY
Pharmacy Address
2855 CAMPUS DR
PLYMOUTH, MN 55441
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Phillip J. Krolik, VP, Finance
(651) 241-8827
Contract Pharmacy Representative
Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
4/14/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session